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Knee Rips Are Sew Fine

Saving the cartilage now may spare child arthritis later

WEDNESDAY, May 30, 2001 (HealthDayNews) -- If your child rips the shock-absorbing cartilage in his knee, the damaged tissue no longer has to be taken out. It often can be fixed so he won't face arthritis a decade or so later, reports a new study.

By sewing up the tear using tiny stitches, surgeons at the Cincinnati Sportsmedicine and Orthopaedic Center repaired cartilage in children that otherwise would have been surgically removed.

The repairs involved a small crescent of cartilage, called a meniscus, sandwiched between the thigh and shin bones, that cushion and protect the knee joint. When it tears, usually from a sports injury or accident, it is painful, and the knee often buckles, swells, clicks and even locks. Treatment for a tear usually involves surgical removal of part or all of the meniscus. But patients who have the surgery often develop arthritis 10 to 15 years later.

"Only 20 to 30 percent of meniscal tears are being repaired," says Dr. Frank Noyes, an orthopedic surgeon and the chairman and CEO of the Cincinnati center. "At least another 30 percent are amenable to more advanced types of repairs."

Noyes recently explained his procedure to the American Orthopaedic Society meeting in San Francisco. Rather than using the usual four or five stitches during arthroscopic surgery in an area with a rich supply of blood, Noyes uses 12 to 15 much smaller stitches where the rip extends into the area without a blood supply. Previously, doctors believed this area was irreparable. Noyes likens his procedure to a plastic surgeon repairing a skin tear.

Noyes and his colleagues followed 61 patients who had the meniscal repair surgery over 14 years. The patients were aged 9 to 19 at the time of the surgery. Four years after surgery, 75 percent of the patients had no pain.

Surgery requires a long time for recovery. Patients must use crutches for four to six weeks and can't play sports for about six months. And at least 25 percent of patients will need more surgery.

"If it's at all possible, we do try to save the meniscus in kids," says Dr. Todd Simmons, an orthopedic surgeon at Children's Memorial Hospital in Chicago, Ill. "The more you can preserve, the better," but surgeons often have to cut off part of the meniscus, he says.

What To Do

"The magic word is 'save'," says Noyes. If your child has a meniscal tear, Noyes says ask the surgeon what can be done to save it and if he or she is familiar with newer techniques.

Simmons says if a tear is less than one centimeter, restricting activity for a while may be all that's needed.

For more information on meniscal tears and treatment options, read this article from the journal The Physician and Sportsmedicine or this one from the University of Virginia Health System.

And read these stories from HealthDay on knee surgery.

SOURCES: Interviews with Frank Noyes, M.D., chairman and CEO of Cincinnati Sportsmedicine and Orthopaedic Center, Ohio; Todd Simmons, M.D., orthopaedic surgeon, Children's Memorial Hospital, Chicago, Ill.; abstract from March 3, 2001, presentation, American Orthopaedic Society for Sports Medicine's Specialty Day
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